| NPI | 1386272243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 74271) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2026-04-11 |